Does Fat Freezing Work? Two Experts Weigh In on CoolSculpting

Blame it on bikini season, but recently, at dinner parties across the country, a topic is back on the tips of tongues: CoolSculpting. Not a new technology, the fat-freezing procedure formally called cryolipolysis was first discovered after, rumor has it, doctors noticed that children who ate a lot of ice pops experienced fat degradation in their cheeks. “Fat is more temperature-sensitive than your skin,” explains UCLA professor and plastic surgeon Jason Roostaeian, MD. “It goes through the cell death process before your skin does.”

CoolSculpting was first approved by the FDA in 2010, and gained attention when it was rebranded from minor spot treatment to a noninvasive alternative to liposuction, promising to eviscerate love handles and bra bulge with the wave of a cooling paddle. Most recently, the non-surgical fat reduction tool was cleared to tackle loose skin under the chin, a smaller area that is more difficult to alter through natural means like diet and exercise. Sound too good to be true? According to Roostaeian and Manhattan-based CoolSculpting guru Jeannel Astarita, the technology works. Here, they discuss the ins and outs of fat freezing, from weight loss to health risks.

HOW DOES IT WORK?CoolSculpting procedures use rounded paddles in one of four sizes to suction your skin and fat “like a vacuum,” says Roostaeian. While you sit in a reclined chair for up to two hours, cooling panels set to work crystallizing your fat cells. “It’s a mild discomfort that people seem to tolerate pretty well," he says. "[You experience] suction and cooling sensations that eventually go numb.” In fact, the procedural setting is so relaxed that patients can bring laptops to do work, enjoy a movie, or simply nap while the machine goes to work.

WHO IS IT FOR?Above all, emphasizes Roostaeian, CoolSculpting is “for someone who is looking for mild improvements,” explaining that it’s not designed for one-stop-shop major fat removal like liposuction. When clients come to Astarita for a consultation, she considers “their age, skin quality—will it rebound? Will it look good after volume is removed?—and how thick or pinchable their tissue is,” before approving them for treatment, because the suction panels can only treat the tissue it can access. “If someone has thick, firm tissue,” explains Astarita, “I won’t be able to give them a wow result.”

WHAT ARE THE RESULTS?“It often takes a few treatments to get to your optimum results,” says Roostaeian, who admits that a single treatment will yield very minimal change, sometimes imperceptible to clients. “One of the downsides of [CoolSculpting] is there’s a range for any one person. I’ve seen people look at before and after pictures and not be able to see the results.” All hope is not lost, however, because both experts agree that the more treatments you have, the more results you will see. What will happen eventually is an up to 25 percent fat reduction in a treatment area. “At best you get mild fat reduction—a slightly improved waistline, less bulging of any particular area that’s concerning. I would emphasize the word mild.”

WILL IT MAKE YOU LOSE WEIGHT?"None of these devices shed pounds,” says Astarita, reminding potential patients that muscle weighs more than fat. When you’re shedding 25 percent of fat in a handful of tissue, it won’t add up to much on the scale, but, she counters, “When [you lose] what’s spilling over the top of your pants or your bra, it counts.” Her clients come to her in search of better proportions at their current weight, and may leave having dropped “one or two sizes in clothing.”

IS IT PERMANENT?“I really emphasize to my patients, yes it’s a permanent fat reduction technology, but only if you control your weight. If you gain weight, it will go somewhere,” says Astarita. Lasting improvements to your body can also occur by changing your behavior through nutrition and exercise. “A little bit of this is on you: If you’re going to do 14 cycles and not change your diet and eating habits at all, [your body] is not going to change at all.”

WHEN SHOULD YOU START IT?With vacations and weddings on the horizon, Roostaeian recommends scheduling your session three months in advance, six at the most. Results are not visible for at least four weeks, with the fat loss reaching its peak at around eight. “By twelve weeks your skin smooths out and looks prettier,” says Astarita. “That’s the cherry on top.” But, reminds Roostaeian, “the results after one treatment are almost always inadequate. Each [treatment] has a downtime, so you want at least six to eight weeks [between appointments].”

IS IT SAFE?Because this is a noninvasive procedure, the risks, comparatively speaking, are very low. Contour irregularities can occur the same way they might in liposuction. While the CoolSculpting machine leaves less room for human error in terms of fat removal, it also has its limitations in terms of fine-tuning removal the way an artful plastic surgeon might by hand. So, too, a potential complication lies with your numbed nerves feeling as though they’ve fallen asleep for “weeks if not months—that can happen,” acknowledges Roostaeian. Wounds will not occur, and swelling is minimal. Further risks should be discussed with your doctor.